Ignoring patient treatment preferences leads to 'silent misdiagnosis'

Nov 9, 2012 10:21am

The doctor doesn't always know what's best. According to a new BMJ Group study, providers often ignore patient preferences in their treatment, leading to a "silent misdiagnosis."

There's a gap between what patients want and what doctors think they want, according to Albert Mulley from The Dartmouth Center for Health Care Delivery Science, as well as Chris Trimble and Glyn Elwyn from Cardiff University in Wales. For example, physicians in one study thought the number one priority for 71 percent of breast cancer patients was keeping their breast, but it was actually only 7 percent.

In another study demonstrating a disconnect in communication, when patients with benign prostate disease were informed about the risks of sexual dysfunction, 40 percent fewer of them preferred surgery.

Researchers noted patients must be informed of all the risks and benefits of treatment, which can greatly affect their preferences.

"Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs," the study states.

According to a nationwide study published last month in the Journal of the American Medical Association, 90 percent of patients want options and not just a best recommendation, demonstrating a greater need for shared decision making.

But it takes more than simply asking what patients want, the Dartmouth Center and Cardiff University researchers noted. They encouraged providers to adopt a mindset of scientific detachment, which means resisting the urge to recommend treatment that the doctor specializes in. Study authors recommended using data to formulate a provisional diagnosis and engaging the patient in shared decision making.